Systems and methods to locate an implantable stimulator device inside a subject

ABSTRACT

Implementations provide a method that includes: placing a controller device over a surface region of the patient where the implantable wireless stimulation device has been implanted; configuring the controller device to (i) monitor a return loss representing electrical power reflected from the implantable wireless stimulation device to the controller device; (ii) compute a first path loss metric based on a first monitored return loss when the controller device is place over a first location within the surface region; (iii) compute a second path loss metric based on a second monitored return loss when the controller device is over a second location within the surface region; and (iv) generate a feedback to an operator to indicate whether the second path loss is smaller than the first path loss such that the controller device is placed at a location with more electrical energy non-inductively transferred to the implantable wireless stimulation device.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.16/196,909, filed Nov. 20, 2018, which claims the benefit of U.S.Provisional Application No. 62/588,625, filed Nov. 20, 2017, and titled“Systems and Methods to Locate an Implantable Stimulator Device Inside aSubject.” The disclosure of each of the foregoing applications isincorporated herein by reference.

TECHNICAL FIELD

This application relates generally to implantable stimulator devices.

BACKGROUND

Modulation of excitable tissue in the body by electrical stimulation hasbecome an important type of therapy for patients with chronic disablingconditions, including pain, movement initiation and control, involuntarymovements, vascular insufficiency, heart arrhythmias and various othermodalities. A variety of therapeutic intra-body electrical stimulationtechniques can be utilized to provide therapeutic relief for theseconditions. For instance, devices may be used to deliver stimulatorysignals to excitable tissue, record vital signs, perform pacing ordefibrillation operations, record action potential activity fromtargeted tissue, control drug release from time-release capsules or drugpump units, or interface with the auditory system to assist withhearing.

SUMMARY

In one aspect, some implementations provide a method to locate animplantable wireless stimulation device implanted inside a patient andconfigured to receive electrical energy wirelessly from outside thepatient via non-inductive coupling, the method including: placing acontroller device over a surface region of the patient where theimplantable wireless stimulation device has been implanted; configuringthe controller device to non-inductively couple to the implantablewireless stimulation device such that the controller device: monitors,by modulating an impedance of a receiving non-inductive antenna on theimplantable wireless stimulation device, a return loss representingelectrical power reflected from the implantable wireless stimulationdevice to the controller device; computes a first path loss metric basedon a first monitored return loss when the controller device is placeover a first location within the surface region; computes a second pathloss metric based on a second monitored return loss when the controllerdevice is over a second location within the surface region; andgenerates a feedback to an operator to indicate whether the second pathloss is smaller than the first path loss such that the controller deviceis placed at a location with more electrical energy non-inductivelytransferred to the implantable wireless stimulation device.

Implementations may include one or more of the following features.

The method may further include: configuring the controller device tomonitor the return loss based on a weighted sum of multiple measurementvalues. The method may further include: configuring the controllerdevice to monitor the return loss by implementing a finite impulseresponse (FIR) filter to reduce noise contributions from the multiplemeasurement values. The method may further include: configuring thecontroller device to monitor the return loss by removing a baseline fromthe weighted sum of multiple measurement values. The method may furtherinclude: configuring the controller device to monitor the return loss byremoving a baseline from the weighted sum of multiple measurementvalues. The baseline may be removed by taking a time derivative of themultiple measured values.

The method may further include: configuring the controller device togenerate a feedback by producing an audio signal to the operatorindicating when more or less electrical energy is non-inductivelytransferred. The audio signal may be generated with increased pitch oramplitude when more electrical energy is non-inductively transferred atthe second location than at the first location. The audio signal may begenerated with decreased pitch or amplitude when less electrical energyis non-inductively transferred at the second location than at the firstlocation.

The method may further include: configuring the controller device togenerate a feedback by producing a visual signal to the operatorindicating when more or less electrical energy is non-inductivelytransferred. The visual signal may be generated with increased blinkingfrequency or amplitude when more electrical energy is non-inductivelytransferred at the second location than at the first location. Thevisual signal may be generated with decreased blinking frequency oramplitude when less electrical energy is non-inductively transferred atthe second location than at the first location.

The method may further include: configuring the controller device togenerate a haptic feedback to the operator indicating when more or lesselectrical energy is non-inductively transferred. The haptic feedbackmay be generated with increased vibration frequency or amplitude whenmore electrical energy is non-inductively transferred at the secondlocation than at the first location. The haptic feedback may begenerated with decreased blinking frequency when less electrical energyis non-inductively transferred at the second location than at the firstlocation.

In another aspect, some implementations provide a system including: acontroller device comprising an antenna, a processor, and one or morememory storage devices; an implantable wireless stimulation deviceincluding: a non-inductive antenna configured to receive an input signalfrom the antenna of the controller device via radiative coupling; acircuit configured to extract electric energy from the input signal; andone or more electrodes configured to stimulate neural tissue of asubject solely using the electric energy extracted from the inputsignal, wherein the controller device is configured to: monitor, bymodulating an impedance of the non-inductive antenna on the implantablewireless stimulation device, a return loss representing electrical powerreflected from the implantable wireless stimulation device to thecontroller device; compute a first path loss metric based on a firstmonitored return loss when the controller device is place over a firstlocation within a surface region of the subject; compute a second pathloss metric based on a second monitored return loss when the controllerdevice is over a second location within the surface region of thesubject; and generate a feedback to indicate whether the second pathloss is smaller than the first path loss such that the controller deviceis placed at a location with more electrical energy non-inductivelytransferred to the implantable wireless stimulation device.

Implementations may include one or more of the following features.

The controller device may be configured to monitor the return loss basedon a weighted sum of multiple measured values. The controller device maybe further configured to monitor the return loss by implementing afinite impulse response (FIR) filter to reduce noise contributions fromthe multiple measured values. The controller device may be furtherconfigured to monitor the return loss by removing a baseline from theweighted sum of multiple measured values. The controller device may befurther configured to generate a feedback to indicate whether more orless electrical energy is non-inductively transferred from thecontroller device to the implantable wireless stimulation device.

The details of one or more implementations are set forth in theaccompanying drawings and the description below. Other features,objects, and advantages will be apparent from the description anddrawings, and from the claims.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 depicts a high-level diagram of an example of a wirelessstimulation system.

FIG. 2 depicts a more detailed diagram of an example of the wirelessstimulation system.

FIG. 3A is an illustration of an example of an implementation of themicrowave field stimulator (MFS) transmitter for wireless power transferto an implanted dipole antenna.

FIG. 3B is another illustration of an example of a return loss (RL) andvoltage standing wave ratio (VSWR) based implant location sensor system.

FIG. 3C is yet another illustration of an example of a 3D representationof the search surface with VSWR based implant location detection withminimum path loss.

FIG. 4A-41 show various examples from simulation computations for RL andVSWR-based implant location detection.

Like reference symbols in the various drawings indicate like elements.

DETAILED DESCRIPTION

In various implementations, systems and methods are disclosed forapplying one or more electrical impulses to targeted excitable tissue,such as nerves, for treating chronic pain, inflammation, arthritis,sleep apnea, seizures, incontinence, pain associated with cancer,incontinence, problems of movement initiation and control, involuntarymovements, vascular insufficiency, heart arrhythmias, obesity, diabetes,craniofacial pain, such as migraines or cluster headaches, and otherdisorders. In certain embodiments, a device may be used to sendelectrical energy to targeted nerve tissue by using remote radiofrequency (RF) energy without cables or inductive coupling to power animplanted wireless stimulator device. The targeted nerves can include,but are not limited to, the spinal cord and surrounding areas, includingthe dorsal horn, dorsal root ganglion, the exiting nerve roots, nerveganglions, the dorsal column fibers and the peripheral nerve bundlesleaving the dorsal column and brain, such as the vagus, occipital,trigeminal, hypoglossal, sacral, coccygeal nerves and the like.

A wireless stimulation system can include an implantable stimulatordevice with one or more electrodes and one or more conductive antennas(for example, dipole or patch antennas), and internal circuitry fordetecting pulse instructions, and rectification of RF electrical energy.The system may further comprise an external controller and antenna fortransmitting radio frequency or microwave energy from an external sourceto the implantable stimulator device with neither cables nor inductivecoupling to provide power.

In various implementations, the wireless implantable stimulator deviceis powered wirelessly (and therefore does not require a wiredconnection) and contains the circuitry necessary to receive the pulseinstructions from a source external to the body. For example, variousembodiments employ internal dipole (or other) antenna configuration(s)to receive RF power through electrical radiative coupling, and thereceived RF power is used to power the implantable stimulator device.This allows such devices to produce electrical currents capable ofstimulating nerve bundles without a physical connection to animplantable pulse generator (IPG) or use of an inductive coil.

In some implementations, a passive relay module may be configured as animplantable device to couple electromagnetic energy radiated from anexternal transmitting antenna to a wireless implantable stimulatordevice. In one example, the implantable device includes two monopolecoupler arms connected to each other by a cable. One monopole couplerarm may be implanted in a parallel configuration with the externaltransmitting antenna such that linearly polarized electromagnetic wavesradiated from the external transmitting antenna are received by thismonopole coupler arm. Through the cable, the received electromagneticwaves may propagate to the other monopole coupler arm. In a reciprocalmanner, this monopole coupler arm may radiate the receivedelectromagnetic energy to the receiving antenna of the stimulatordevice. To effectively radiate the received electromagnetic energy tothe receiving antenna of the stimulator device, parallel alignment ofthis other monopole coupler arm and the receiving antenna again may beused. In some cases, lengths of the monopole arms and length of thecable can be tailored to improve transmission efficiency, for example,at a particular operating frequency.

Some implementations utilize non-battery wireless power transferimplants, a new class of devices that can be constructed in very smallform factors, enabling a minimal surgical incision and potentiallyunlimited product life, free of limitations and complications associatedwith battery powered devices. However, wireless power transfer facesvarious challenges. An implanted antenna is ideally very small in sizeto pass through a needle or cannula in order to enable a minimallyinvasive surgery. Generally a small antenna receives less RF power thana larger antenna, meaning the efficiency of power transfer to a verysmall antenna can be poor. Compounding the problem is the limited RFpower that can be delivered by the external transmitting source becausethe Specific Absorption Rate (SAR) of RF inside the human body must tokept within safety limits. As such, optimum power transfer efficiency(or minimum path loss) must be maintained during wireless power transferfor implantable medical devices. To affect optimum power transfer, theexternal transmitting antenna must be aligned on the body in a favorableposition relative to the implant. Estimating the location of the implantwas historically only feasible using a medical imaging system, such asx-ray or ultrasound. Some implementations disclosed herein enablelocating the in-situ receiver antenna, without the use of complex andexpensive medical imaging techniques.

Further descriptions of exemplary wireless systems for providing neuralstimulation to a patient can be found in commonly-assigned, publishedPCT applications PCT/US2012/23029 filed Jan. 28, 2011 and published Aug.2, 2012, PCT/US2012/32200 filed Apr. 11, 2011 and published Oct. 11,2012, PCT/US2012/48903, filed Jan. 28, 2011 and published Feb. 7, 2013,PCT/US2012/50633, filed Aug. 12, 2011 and published Feb. 21, 2013 andPCT/US2012/55746, filed Sep. 15, 2011 and published Mar. 21, 2013, thecomplete disclosures of which are incorporated by reference.

FIG. 1 depicts a high-level diagram of an example of a wirelessstimulation system. The wireless stimulation system may include fourmajor components, namely, a programmer module 102, a RF pulse generatormodule 106, a transmitting (TX) antenna 110 (for example, a patchantenna, slot antenna, or a dipole antenna), and an implanted wirelessstimulator device 114. The programmer module 102 may be a computerdevice, such as a smart phone, running a software application thatsupports a wireless connection 104, such as Bluetooth®. The applicationcan enable the user to view the system status and diagnostics, changevarious parameters, increase/decrease the desired stimulus amplitude ofthe electrical pulses, and adjust feedback sensitivity of the RF pulsegenerator module 106, among other functions.

The RF pulse generator module 106 may include communication electronicsthat support the wireless connection 104 and the battery to power thegenerator electronics. In some implementations, the RF pulse generatormodule 106 includes the TX antenna embedded into its packaging formfactor, while in other implementations, the TX antenna is connected tothe RF pulse generator module 106 through a wired connection 108 or awireless connection (not shown). The TX antenna 110 may be coupleddirectly to tissue to create an electric field that powers the implantedwireless stimulator device 114. The TX antenna 110 communicates with theimplanted wireless stimulator device 114 through an RF interface. Forinstance, the TX antenna 110 radiates an RF transmission signal that ismodulated and encoded by the RF pulse generator module 110. Theimplanted wireless stimulator device of module 114 contains one or moreantennas, such as dipole antenna(s), to receive and transmit through RFinterface 112. In particular, the coupling mechanism between antenna 110and the one or more antennas on the implanted wireless stimulationdevice of module 114 utilizes electrical radiative coupling and notinductive coupling. In other words, the coupling is through an electricfield rather than a magnetic field.

Through this electrical radiative coupling, the TX antenna 110 canprovide an input signal to the implanted wireless stimulator device 114.This input signal contains energy and may contain information encodingstimulus waveforms to be applied at the electrodes of the implantedwireless stimulator device 114. In some implementations, the power levelof this input signal directly determines an applied amplitude (forexample, power, current, or voltage) of the one or more electricalpulses created using the electrical energy contained in the inputsignal. Within the implanted wireless stimulator device 114 arecomponents for demodulating the RF transmission signal, and electrodesto deliver the stimulation to surrounding neural tissue.

The RF pulse generator module 106 can be implanted subcutaneously, or itcan be worn external to the body. When external to the body, the RFgenerator module 106 can be incorporated into a belt or harness designto allow for electric radiative coupling through the skin and underlyingtissue to transfer power and/or control parameters to the implantedwireless stimulator device 114. In either event, receiver circuit(s)internal to the wireless stimulator device 114 (or cylindrical wirelessimplantable stimulator device 1400 shown in FIGS. 14A and 14B, helicalwireless implantable stimulator device 1900 shown in FIGS. 19A to 19C)can capture the energy radiated by the TX antenna 110 and convert thisenergy to an electrical waveform. The receiver circuit(s) may furthermodify the waveform to create an electrical pulse suitable for thestimulation of neural tissue.

In some implementations, the RF pulse generator module 106 can remotelycontrol the stimulus parameters (that is, the parameters of theelectrical pulses applied to the neural tissue) and monitor feedbackfrom the wireless stimulator device 114 based on RF signals receivedfrom the implanted wireless stimulator device 114. A feedback detectionalgorithm implemented by the RF pulse generator module 106 can monitordata sent wirelessly from the implanted wireless stimulator device 114,including information about the energy that the implanted wirelessstimulator device 114 is receiving from the RF pulse generator andinformation about the stimulus waveform being delivered to theelectrodes. In order to provide an effective therapy for a given medicalcondition, the system can be tuned to provide the optimal amount ofexcitation or inhibition to the nerve fibers by electrical stimulation.A closed loop feedback control method can be used in which the outputsignals from the implanted wireless stimulator device 114 are monitoredand used to determine the appropriate level of neural stimulation formaintaining effective therapy, or, in some cases, open loop control canbe used.

FIG. 2 depicts a detailed diagram of an example of the wirelessstimulation system. As depicted, the programming module 102 may compriseuser input system 202 and communication subsystem 208. The user inputsystem 221 may allow various parameter settings to be adjusted (in somecases, in an open loop fashion) by the user in the form of instructionsets. The communication subsystem 208 may transmit these instructionsets (and other information) via the wireless connection 104, such asBluetooth or Wi-Fi, to the RF pulse generator module 106, as well asreceive data from module 106.

For instance, the programmer module 102, which can be utilized formultiple users, such as a patient's control unit or clinician'sprogrammer unit, can be used to send stimulation parameters to the RFpulse generator module 106. The stimulation parameters that can becontrolled may include pulse amplitude, pulse frequency, and pulse widthin the ranges shown in Table 1. In this context the term pulse refers tothe phase of the waveform that directly produces stimulation of thetissue; the parameters of the charge-balancing phase (described below)can similarly be controlled. The patient and/or the clinician can alsooptionally control overall duration and pattern of treatment.

Stimulation Parameter Table 1 Pulse Amplitude: 0 to 25 mA PulseFrequency: 0 to 20000 Hz Pulse Width: 0 to 2 ms

The RF pulse generator module 106 may be initially programmed to meetthe specific parameter settings for each individual patient during theinitial implantation procedure. Because medical conditions or the tissueproperties can change over time, the ability to re-adjust the parametersettings may be beneficial to ensure ongoing efficacy of the neuralmodulation therapy.

The programmer module 102 may be functionally a smart device andassociated application. The smart device hardware may include a CPU 206and be used as a vehicle to handle touchscreen input on a graphical userinterface (GUI) 204, for processing and storing data.

The RF pulse generator module 106 may be connected via wired connection108 to an external TX antenna 110. Alternatively, both the antenna andthe RF pulse generator are located subcutaneously (not shown).

The signals sent by RF pulse generator module 106 to the implantedwireless stimulator device 114 may include both power andparameter-setting attributes in regards to stimulus waveform, amplitude,pulse width, and frequency. The RF pulse generator module 106 can alsofunction as a wireless receiving unit that receives feedback signalsfrom the implanted wireless stimulator device 114. To that end, the RFpulse generator module 106 may contain microelectronics or othercircuitry to handle the generation of the signals transmitted to thedevice 114 as well as handle feedback signals, such as those from thestimulator device 114. For example, the RF pulse generator module 106may comprise controller subsystem 214, high-frequency oscillator 218, RFamplifier 216, a RF switch, and a feedback subsystem 212.

The controller subsystem 214 may include a CPU 230 to handle dataprocessing, a memory subsystem 228 such as a local memory, communicationsubsystem 234 to communicate with programmer module 102 (includingreceiving stimulation parameters from programmer module), pulsegenerator circuitry 236, and digital/analog (D/A) converters 232.

The controller subsystem 214 may be used by the patient and/or theclinician to control the stimulation parameter settings (for example, bycontrolling the parameters of the signal sent from RF pulse generatormodule 106 to the stimulator device 114). These parameter settings canaffect, for example, the power, current level, or shape of the one ormore electrical pulses. The programming of the stimulation parameterscan be performed using the programming module 102, as described above,to set the repetition rate, pulse width, amplitude, and waveform thatwill be transmitted by RF energy to the receiving (RX) antenna 238,typically a dipole antenna (although other types may be used), in theimplanted wireless stimulation device 214. The clinician may have theoption of locking and/or hiding certain settings within the programmerinterface, thus limiting the patient's ability to view or adjust certainparameters because adjustment of certain parameters may require detailedmedical knowledge of neurophysiology, neuro-anatomy, protocols forneural modulation, and safety limits of electrical stimulation.

The controller subsystem 214 may store received parameters in the localmemory subsystem 228, until the parameters are modified by new datareceived from the programming module 102. The CPU 206 may use theparameters stored in the local memory to control the RF pulse generatorcircuitry 236 to generate a pulse timing waveform that is modulated by ahigh frequency oscillator 218 in the range from 300 MHz to 8 GHz(preferably between about 700 MHz and 5.8 GHz and more preferablybetween about 800 MHz and 1.3 GHz). The resulting RF signal may then beamplified by RF amplifier 226 and then sent through an RF switch 223 tothe TX antenna 110 to reach through depths of tissue to the RX antenna238.

In some implementations, the RF signal sent by TX antenna 110 may simplybe a power transmission signal used by the wireless stimulation devicemodule 114 to generate electric pulses. In other implementations, adigital signal may also be transmitted to the wireless stimulator device114 to send instructions about the configuration of the wirelessstimulator device 114. The digital signal is used to modulate thecarrier signal that is coupled onto the implanted antenna(s) 238 anddoes not interfere with the input received on the same stimulator deviceto power the device. In one embodiment the digital signal and poweringsignal are combined into one signal, where the digital signal is used tomodulate the RF powering signal, and thus the wireless stimulationdevice is powered directly by the received digital signal; separatesubsystems in the wireless stimulation device harness the powercontained in the signal and interpret the data content of the signal.

The RF switch 223 may be a multipurpose device such as a dualdirectional coupler, which passes the RF pulses to the TX antenna 110with minimal insertion loss while simultaneously providing two low-leveloutputs to the feedback subsystem 212; one output delivers a forwardpower signal to the feedback subsystem 212, where the forward powersignal is an attenuated version of the RF pulse sent to the TX antenna110, and the other output delivers a reverse power signal to a differentport of the feedback subsystem 212, where reverse power is an attenuatedversion of the reflected RF energy from the TX Antenna 110. Thereflected RF energy and/or RF signals from the wireless stimulatordevice 114 are processed in the feedback subsystem 212.

The feedback subsystem 212 of the RF pulse generator module 106 mayinclude reception circuitry to receive and extract telemetry or otherfeedback signals from the wireless stimulator device 114 and/orreflected RF energy from the signal sent by TX antenna 110. The feedbacksubsystem may include an amplifier 226, a filter 224, a demodulator 222,and an A/D converter 220.

The feedback subsystem 212 receives the forward power signal andconverts this high-frequency AC signal to a DC level that can be sampledand sent to the controller subsystem 214. In this way thecharacteristics of the generated RF pulse can be compared to a referencesignal within the controller subsystem 214. If a disparity (error)exists in any parameter, the controller subsystem 214 can adjust theoutput to the RF pulse generator 106. The nature of the adjustment canbe, for example, proportional to the computed error. The controllersubsystem 214 can incorporate additional inputs and limits on itsadjustment scheme such as the signal amplitude of the reverse power andany predetermined maximum or minimum values for various pulseparameters.

The reverse power signal can for example be used to detect faultconditions in the RF-power delivery system. In an ideal condition, whenthe TX antenna 110 has perfectly matched impedance to the tissue that itcontacts, the electromagnetic waves generated from the RF pulsegenerator 106 pass unimpeded from the TX antenna 110 into the bodytissue. However, in real-world applications a large degree ofvariability may exist in the body types of users, types of clothingworn, and positioning of the antenna 110 relative to the body surface.Since the impedance of the antenna 110 depends on the relativepermittivity of the underlying tissue and any intervening materials, andalso depends on the overall separation distance of the antenna from theskin, in any given application there can be an impedance mismatch at theinterface of the TX antenna 110 with the body surface. When such amismatch occurs, the electromagnetic waves sent from the RF pulsegenerator 106 are partially reflected at this interface, and thisreflected energy propagates backward through the antenna feed.

The dual directional coupler RF switch 223 may prevent the reflected RFenergy propagating back into the amplifier 226, and may attenuate thisreflected RF signal and send the attenuated signal as the reverse powersignal to the feedback subsystem 212. The feedback subsystem 212 canconvert this high-frequency AC signal to a DC level that can be sampledand sent to the controller subsystem 214. The controller subsystem 214can then calculate the ratio of the amplitude of the reverse powersignal to the amplitude of the forward power signal. The ratio of theamplitude of reverse power signal to the amplitude level of forwardpower may indicate severity of the impedance mismatch.

In order to sense impedance mismatch conditions, the controllersubsystem 214 can measure the reflected-power ratio in real time, andaccording to preset thresholds for this measurement, the controllersubsystem 214 can modify the level of RF power generated by the RF pulsegenerator 106. For example, for a moderate degree of reflected power thecourse of action can be for the controller subsystem 214 to increase theamplitude of RF power sent to the TX antenna 110, as would be needed tocompensate for slightly non-optimum but acceptable TX antenna couplingto the body. For higher ratios of reflected power, the course of actioncan be to prevent operation of the RF pulse generator 106 and set afault code to indicate that the TX antenna 110 has little or no couplingwith the body. This type of reflected-power fault condition can also begenerated by a poor or broken connection to the TX antenna. In eithercase, it may be desirable to stop RF transmission when thereflected-power ratio is above a defined threshold, because internallyreflected power can result in unwanted heating of internal components,and this fault condition means the system cannot deliver sufficientpower to the implanted wireless stimulation device and thus cannotdeliver therapy to the user.

The controller 242 of the wireless stimulator device 114 may transmitinformational signals, such as a telemetry signal, through the antenna238 to communicate with the RF pulse generator module 106. For example,the telemetry signal from the wireless stimulator device 114 may becoupled to its dipole antenna(s) 238, The antenna(s) 238 may beconnected to electrodes 254 in contact with tissue to provide a returnpath for the transmitted signal. An A/D (not shown) converter can beused to transfer stored data to a serialized pattern that can betransmitted on the pulse-modulated signal from the internal antenna(s)238 of the wireless stimulator device 114.

A telemetry signal from the implanted wireless stimulator device 114 mayinclude stimulus parameters such as the power or the amplitude of thecurrent that is delivered to the tissue from the electrodes. Thefeedback signal can be transmitted to the RF pulse generator module 116to indicate the strength of the stimulus at the nerve bundle by means ofcoupling the signal to the implanted RX antenna 238, which radiates thetelemetry signal to the external (or remotely implanted) RF pulsegenerator module 106. The feedback signal can include either or both ananalog and digital telemetry pulse modulated carrier signal. Data suchas stimulation pulse parameters and measured characteristics ofstimulator performance can be stored in an internal memory device withinthe implanted stimulator device 114, and can be sent via the telemetrysignal. The frequency of the carrier signal may be in the range of at300 MHz to 8 GHz (preferably between about 700 MHz and 5.8 GHz and morepreferably between about 800 MHz and 1.3 GHz).

In the feedback subsystem 212, the telemetry signal can bedown-modulated using demodulator 222 and digitized through an analog todigital (A/D) converter 220. The digital telemetry signal may then berouted to a CPU 230 for interpretation. The CPU 230 of the controllersubsystem 214 can compare the reported stimulus parameters to those heldin local memory 228 to verify the wireless stimulator device 114delivered the specified stimuli to tissue. For example, if the wirelessstimulation device reports a lower current than was specified, the powerlevel from the RF pulse generator module 106 can be increased so thatthe implanted wireless stimulator device 114 will have more availablepower for stimulation. The implanted wireless stimulator device 114could alternatively generate telemetry data in real time, for example,at a rate of 8 Kbits per second. All feedback data received from theimplanted stimulator device 114 can be logged against time and sampledto be stored for retrieval to a remote monitoring system accessible bythe health care professional.

The RF signals received by the internal antenna(s) 238 may beconditioned into waveforms that are controlled within the implantablewireless stimulator device 114 by the control subsystem 242 and routedto the appropriate electrodes 254 that are placed in proximity to thetissue to be stimulated. For instance, the RF signal transmitted fromthe RF pulse generator module 106 may be received by RX antenna 238 andprocessed by circuitry, such as waveform conditioning circuitry 240,within the implanted wireless stimulator device 114 to be converted intoelectrical pulses applied to the electrodes 254 through electrodeinterface 252. In some implementations, the implanted wirelessstimulator device 114 contains between two to sixteen electrodes 254.

The waveform conditioning circuitry 240 may include a rectifier 244. Therectified signal may be fed to the controller 242 for receiving encodedinstructions from the RF pulse generator module 106. The rectifiersignal may also be fed to a charge balance component 246 that isconfigured to create one or more electrical pulses such that the one ormore electrical pulses result in a charge balanced electricalstimulation waveform at the one or more electrodes. The charge-balancedpulses are passed through the current limiter 248 to the electrodeinterface 252, which applies the pulses to the electrodes 254 asappropriate.

The current limiter 248 insures the current level of the pulses appliedto the electrodes 254 is not above a threshold current level. In someimplementations, an amplitude (for example, current level, voltagelevel, or power level) of the received RF pulse directly determines theamplitude of the stimulus. In this case, it may be particularlybeneficial to include current limiter 248 to prevent excessive currentor charge being delivered through the electrodes, although currentlimiter 248 may be used in other implementations. Generally, for a givenelectrode having several square millimeters surface area, it is thecharge per phase that should be limited for safety (where the chargedelivered by a stimulus phase is the integral of the current). But, insome cases, the limit can instead be placed only on the currentamplitude. The current limiter 248 can automatically limit or “clip” thestimulus phase to maintain the phase within the safety limit.

The controller 250 of the stimulator 205 may communicate with theelectrode interface 252 to control various aspects of the electrodesetup and pulses applied to the electrodes 254. The electrode interface252 may act as a multiplex and control the polarity and switching ofeach of the electrodes 254. For instance, in some implementations, thewireless stimulator 106 has multiple electrodes 254 in contact withtissue, and for a given stimulus the RF pulse generator module 106 canassign one or more electrodes to 1) act as a stimulating electrode, 2)act as a return electrode, or 3) be inactive. The assignment can beeffectuated by virtue of RF pulse generator module 106 sendinginstructions to the implantable stimulator 205.

Also, in some implementations, for a given stimulus pulse, thecontroller 250 may control the electrode interface 252 to divide thecurrent among the designated stimulating electrodes. This control overelectrode assignment and current control can be advantageous because inpractice the electrodes 254 may be spatially distributed along variousneural structures, and through strategic selection of the stimulatingelectrode location and the proportion of current specified for eachlocation, the aggregate current distribution in tissue can be modifiedto selectively activate specific neural targets. This strategy ofcurrent steering can improve the therapeutic effect for the patient.

In another implementation, the time course of stimuli may bemanipulated. A given stimulus waveform may be initiated and terminatedat selected times, and this time course may be synchronized across allstimulating and return electrodes; further, the frequency of repetitionof this stimulus cycle may be synchronous for all the electrodes.However, controller 250, on its own or in response to instructions frompulse generator 106, can control electrode interface 252 to designateone or more subsets of electrodes to deliver stimulus waveforms withnon-synchronous start and stop times, and the frequency of repetition ofeach stimulus cycle can be arbitrarily and independently specified.

In some implementations, the controller 250 can arbitrarily shape thestimulus waveform amplitude, and it may do so in response toinstructions from pulse generator 106. The stimulus phase may bedelivered by a constant-current source or a constant-voltage source, andthis type of control may generate characteristic waveforms that arestatic, e.g. a constant-current source generates a characteristicrectangular pulse in which the current waveform has a very steep rise, aconstant amplitude for the duration of the stimulus, and then a verysteep return to baseline. Alternatively, or additionally, the controller250 can increase or decrease the level of current at any time during thestimulus phase and/or during the charge-balancing phase. Thus, in someimplementations, the controller 250 can deliver arbitrarily shapedstimulus waveforms such as a triangular pulse, sinusoidal pulse, orGaussian pulse for example. Similarly, the charge-balancing phase can bearbitrarily amplitude-shaped, and similarly a leading anodic pulse(prior to the stimulus phase) may also be amplitude-shaped.

As described above, the wireless stimulator device 114 may include acharge-balancing component 246. Biphasic stimulating current pulsesensure that no net charge appears at the electrode after eachstimulation cycle and the electrochemical processes are balanced toprevent net DC currents. The wireless stimulator device 114 may beconfigured to ensure that the resulting stimulus waveform has a net zerocharge. Charge balanced stimuli are thought to have minimal damagingeffects on tissue by reducing or eliminating electrochemical reactionproducts created at the electrode-tissue interface.

In some implementations, the charge balance component 246 uses aDC-blocking capacitor(s) placed electrically in series with thestimulating electrodes and body tissue, between the point of stimulusgeneration within the stimulator circuitry and the point of stimulusdelivery to tissue. In a multi-electrode stimulator, one charge-balancecapacitor(s) may be used for each electrode or a centralizedcapacitor(s) may be used within the stimulator circuitry prior to thepoint of electrode selection. The stimulus waveform created prior to thecharge-balance capacitor, called the drive waveform, may be controlledsuch that its amplitude is varied during the duration of the drivepulse. The shape of the stimulus waveform may be modified in thisfashion to create a physiologically advantageous stimulus.

In some implementations, the wireless stimulator device 114 may create adrive-waveform envelope that follows the envelope of the RF pulsereceived by the receiving dipole antenna(s) 238. In this case, the RFpulse generator module 106 can directly control the envelope of thedrive waveform within the wireless stimulator device 114, and thus noenergy storage may be required inside the stimulator itself. In thisimplementation, the stimulator circuitry may modify the envelope of thedrive waveform or may pass it directly to the charge-balance capacitorand/or electrode-selection stage.

In some implementations, the implanted wireless stimulator device 114may deliver a single-phase drive waveform to the charge balancecapacitor or it may deliver multiphase drive waveforms. In the case of asingle-phase drive waveform, for example, a negative-going rectangularpulse, this pulse comprises the physiological stimulus phase, and thecharge-balance capacitor is polarized (charged) during this phase. Afterthe drive pulse is completed, the charge balancing function is performedsolely by the passive discharge of the charge-balance capacitor, whereis dissipates its charge through the tissue in an opposite polarityrelative to the preceding stimulus. In one implementation, a resistorwithin the stimulator facilitates the discharge of the charge-balancecapacitor.

In the case of multiphase drive waveforms the wireless stimulator mayperform internal switching to pass negative-going or positive-goingpulses (phases) to the charge-balance capacitor. These pulses may bedelivered in any sequence and with varying amplitudes and waveformshapes to achieve a desired physiological effect.

In some implementations, the amplitude and timing of stimulus andcharge-balancing phases is controlled by the amplitude and timing of RFpulses from the RF pulse generator module 106, and in others thiscontrol may be administered internally by circuitry onboard the wirelessstimulator device 114, such as controller 250. In the case of onboardcontrol, the amplitude and timing may be specified or modified by datacommands delivered from the pulse generator module 106.

Referring to FIGS. 3A to 3C, some implementation use the microwave fieldstimulator (MFS) transmitter for wireless power transfer, as illustratedin system level diagram 300. The MFS may include a digital signalprocessor 301, gain control 302, phase-locked loop 303, gating amplifier304, pulse-amplitude input matching network 305, boost regulator 306,radio-frequency (RF) amplifier 307, pulse-amplitude harmonic filter 308,antenna 309, tissue boundary 310, passive neural stimulator 311,directional coupler 312, analog-digital converter (ADC) 313, andreceiving dipole antenna 314. As illustrated, implanted electrodes maybe used to pass pulsatile electrical currents of controllable frequency,pulse width and amplitudes. A variety of therapeutic intra-bodyelectrical stimulation techniques may be utilized to treat conditionsthat are known to respond to neural modulation.

Digital signal processor 301 may generate pulse parameters such as pulsewidth, amplitude, and repetition rate. Digital signal processor 301 mayfeed pulse parameters to gain control 302, which can include a digitalto analog converter (DAC). Gain control 302 may generate RF envelope302A to gating amplifier 304. Digital signal processor 301 may feedphase-locked loop 303 with stimulus timing control 301A, which is avoltage signal that drives crystal XTAL 303A to generate RF carrierburst 303B. RF carrier burst 303B arrives at gating amplifier tomodulate RF envelope 302A such that RF pulse 304A is generated to feedpulse-amplitude input matching network 305.

Output from pulse-amplitude input matching network 305 is provided to RFamplifier 307 under a bias voltage from boost regulator 306.Subsequently, a harmonic filter 308 mitigates harmonic distortions andfeeds the filtered output as a high power RF pulse to antenna 309. Thehigh power RF pulse is transmitted from antenna 309 through skin layer310 to reach receiver dipole antenna 314 of the implanted neuralstimulator device 311 so that therapies are applied at tissueelectrodes.

Some implementations incorporate location detection of the implantedneural stimulator device 311 via Γ Sensor subsystem of FIG. 3B. The ΓSensor (“gamma” sensor or “reflection” sensor) is used to measure thevoltage standing wave ratio (VSWR), from which the return loss (RL) iscomputed. The return loss of the RF signal can be exploited to detect abackscatter signal 316 that is modulated by the implanted stimulatordevice 311. The backscatter signal 316 is received at antenna 309 androuted via directional coupler 312 to analog-digital converter (ADC) 313so that an estimate of VSWR 317 may be obtained.

The location detection method can be used to determine the mostadvantageous position for the transmitting antenna 309, therebyminimizing the path loss from the transmitter antenna 309 to thereceiver antenna 314. The operation of searching for the stimulatordevice 311 is premised on the stimulator device 311 modulating theimpedance of its receiving antenna 314. This modulation is detectable bythe Γ Sensor of FIG. 3B, where F is the reflection coefficient (orreturn loss) of the transmitter antenna 309. When the stimulator device311 is configured to operate in location mode, the impedance of receiverantenna 314 is periodically modified by a switched load 316. When theload 316 is changed, the impedance of the receiver antenna 314 isaltered such that the receiver antenna 314 reflects RF energy.Subsequently, the transmitter antenna 309 also experiences an impedancechange, which is detected by the Γ Sensor of FIG. 3B. The measurementsat the Γ Sensor represent the forward and reverse RF power levels, fromwhich Γ is computed. As load 316 at the receiver antenna 314 is activelymodulated by the stimulator device 311, the shift of the signal seen bythe Γ Sensor has an observed magnitude. The magnitude of the shift alsodepends on the coupling of the two antennas. As the transmitter antenna309 is brought closer to the receiver antenna 314, the RF couplingimproves, and the magnitude of signal from the Γ Sensor increases.

When the system is engaged in location mode, the controller 250 monitorsthe reflection coefficient (Γ) and computes the associated VoltageStanding Wave Ratio (VSWR) according to the following equation:

${VSWR} = \frac{1 + {❘\Gamma ❘}}{1 - {❘\Gamma ❘}}$

The path loss decreases (the power transmission improves) as thetransmitter antenna 309 is moved into better alignment with theimplanted receiver antenna 314. As illustrated by the concave 3-Dsurface showing the path loss versus antenna alignment in FIG. 3C, theoptimal location of the transmitter antenna 309 corresponds to theminimum value of the path-loss surface. Finding the low point on thepath-loss surface is the goal of the user while moving the transmitterantenna 309 across the surface of subject's body. While operating inthis mode, the MFS 300 could give audio and/or visual and/or hapticfeedback to the user indicating when the transmitter antenna 309 isapproaching the optimal alignment. By the use of this implant locationmethod, the path loss for the RF power can be substantially minimized,meaning the MFS 300 can provide the most efficient power delivery to thestimulator device 311.

In some implementations, the implant-location algorithm employs a finiteimpulse response (FIR) filter for reducing noise from the Γ Sensor. Bycomputing the summation (SUM) of Γ values from the most recent N pulses,then removing the baseline offset by taking the time derivative of thesmoothed data, the backscatter transitions or “steps” of Γ can beextracted from a noisy signal. In this application, it may beadvantageous to resolve small steps of Γ because the influence of thereceiver antenna 314 upon the value of Γ (measured at the transmitterantenna 309) can be very small relative to the noise.

The backscatter transitions in the time derivative of Γ can be enhancedby raising the result to an M-th power, where M is positive and even,such that any derivative value less than 1.0 can be reduced toapproximate zero, while any value above 1.0 can be enhanced. An exampleof a computationally efficient algorithm to perform the described signalconditioning is as follows:

-   -   Let N be an integer greater than 1, where N is the number of        points or “taps” of the FIR filter. Then calculate the sums:        Sum0, Sum1, Sum2, . . . , Sum5 and corresponding time        derivatives, Delta0, Delta1, Delta2, . . . , Delta5 of the        received signal which in this example is the unprocessed reverse        voltage values (REV(n)) as sampled at the MFS reverse voltage        detector.        -   u1=Sum0        -   Sum0=REV(n)        -   u2=Sum0        -   Delta0=u2−u1        -   u1=Sum1        -   Sum1=(Sum1+Sum0−Sum1/N)        -   u2=Sum1        -   Delta1=u2−u1        -   u1=Sum2        -   Sum2=(Sum2+Sum1/N−Sum2/N)        -   u2=Sum2        -   Delta2=u2−u1        -   u1=Sum3        -   Sum3=(Sum3+Sum2/N−Sum3/N)        -   u2=Sum3        -   Delta3=u2−u1        -   u1=Sum4        -   Sum4=(Sum4+Sum3/N−Sum4/N)        -   u2=Sum4        -   Delta4=u2−u1        -   u1=Sum5        -   Sum5=(Sum5+Sum4/N−Sum5/N)        -   u2=Sum5        -   Delta5=u2−u1

When calculating successive sums, a divide-by-N operation may be addedin order to avoid generation of very large numbers in the computations.The number of data sample points averaged, N, can be chosenstrategically to remove random noise and/or known periodic noisesignals. However, N must be chosen strategically such that the algorithmhas suitable settling time for the given application, and the filteringdoes not obscure the desired signal. For example, when looking forbackscatter signals, N should be less than or equal to the number ofsamples per backscatter period. Otherwise the backscatter signal itselfcan be filtered and lost. In the following examples, N=8, and RF pulserate=3 kHz.

Shown in FIG. 4A is an example of the algorithm results plotted versussample count (horizontal axis), calculated as Sum0 through Sum5. In thisdisplay, Sum0 results are represented by red squares, Sum1 results arerepresented by green circles, Sum2 results are represented by dark bluecircles, Sum3 results are represented by light blue circles, Sum4results are represented by black circles, and Sum5 results arerepresented by magenta circles. FIG. 4B shows the respective timederivatives versus sample count (horizontal axis), for Delta0 throughDelta5. In this display, Delta0 results are represented by red squares,Delta1 results are represented by green squares, Delta2 results arerepresented by dark blue squares, Delta3 results are represented bylight blue squares, Delta4 results are represented by black squares, andDelta5 results are represented by magenta squares. The results show anincrease in the settling time as the number of sums is increased. Sum0results (red squares), for example, has noise with an undesired periodicbeat. In one instance, letting N=8 (eight points averaged) may filterout the beat sufficiently while minimizing settling lag. By the 5^(th)sum (magenta circles), the noise in the results is substantiallysmoothed out. If derivatives are subsequently taken and raised to aneven power, the result will be a positive value. The derivatives smallerthan 1.0 can be reduced, while any derivatives larger than 1.0 can beenhanced. The derivative of the 5^(th) pass, raised to the 4^(th) power,(Delta5){circumflex over ( )}4, versus sample count (horizontal axis) isshown in FIG. 4C. In this case the backscatter signal was turned off andonly environmental noise was present. With this algorithm, the unwantednoise was substantially filtered out, as shown in FIG. 4C.

FIG. 4D shows a backscatter signal 316 for an implanted stimulatordevice 311 that is far from the transmitter antenna 309, and the changein Γ is near the limit of detection. In FIG. 4E the same result is shownon a smaller time scale to show the signal in detail. From sample count1,000 to 1,200, the backscatter signal 316 was turned off, then it wasenabled from 1,200 to about 1,800, then it was off again to sample count2,000. The red trace is results from Sum0 which is the backscattersignal 316 superimposed on the noise. The magenta trace shows resultsfrom Sum5, which is flat when the backscatter signal 316 is off and issinusoidal when the backscatter signal 316 is on. The derivative ofresults from Sum5, raised to the 4^(th) power, (Delta5){circumflex over( )}4, enhances the signal as shown in FIG. 4F, which demonstrates aweak backscatter signal can be detected in a noisy environment. Incontrast, a strong backscatter signal 316 with the same filteringalgorithm is shown FIG. 4G. A stronger signal such as that of FIG. 4Gmay occur when the path loss from the transmitter antenna 309 to thereceiver antenna 314 is minimized. Two additional examples of detectionof backscatter signal 316 are shown in FIGS. 4H and 41 . These signalsare considered to be difficult to resolve because the scatteringintervals may be randomly timed. FIG. 4H shows the case when twoimplanted stimulator devices 311 are backscattering simultaneously, andFIG. 4H shows the case when an implanted stimulator device 311 generateschaotic backscattering.

A number of implementations have been described. Nevertheless, it willbe understood that various modifications may be made. Accordingly, otherimplementations are within the scope of the following claims.

What is claimed is:
 1. A method to locate an implantable wirelessstimulation device implanted inside a patient and configured to receiveelectrical energy wirelessly from outside the patient via non-inductivecoupling, the method comprising: placing a controller device over asurface region of the patient where the implantable wireless stimulationdevice has been implanted; configuring the controller device tonon-inductively couple to the implantable wireless stimulation devicesuch that the controller device: monitors, by modulating an impedance ofa receiving non-inductive antenna on the implantable wirelessstimulation device, a return loss representing electrical powerreflected from the implantable wireless stimulation device to thecontroller device; computes a first path loss metric based on a firstmonitored return loss when the controller device is place over a firstlocation within the surface region; computes a second path loss metricbased on a second monitored return loss when the controller device isover a second location within the surface region; and generates afeedback to an operator to indicate whether the second path loss issmaller than the first path loss such that the controller device isplaced at a location with more electrical energy non-inductivelytransferred to the implantable wireless stimulation device.